As healthcare professionals continue to navigate the COVID-19 pandemic, it's important to understand how it has impacted healthcare trends. “Trends in Sepsis and Pneumonia During COVID-19: Lessons From BPCIA,” a recent research article published in The American Journal of Managed Care, explores how COVID-19 has impacted sepsis and pneumonia care and costs. Coauthored by Alyssa Dahl, DataGen’s senior director of advanced analytics, and John Kalamaras, DataGen’s director of business intelligence analytics, along with experts from the Association of American Medical Colleges, the article explores the changes in cost and utilization for sepsis and pneumonia in non-COVID-19 episodes before and during the pandemic, and during the pandemic for patients with and without COVID-19. The analysis used claims data from eight teaching hospitals participating in sepsis and pneumonia episodes in the Bundled Payments for Care Improvement Advanced model. BPCIA is a Medicare value-based care bundle...

Fulfilling the state’s requirements to report patient data to the Statewide Planning and Research Cooperative System can be a complex, confusing task. A single department’s data volume, let alone an entire facility’s, can be overwhelming. Many ambulatory surgery centers don’t even know that SPARCS reporting requirements apply to them. The New York State Department of Health requires hospitals and ASCs to submit clinical, billing, admission, discharge and transfer data to SPARCS. The state uses your patient data to track and report on community trends and set more accurate reimbursement rates. But what do you get other than a repeating cycle of submission error alerts on claims that have already been paid? SPARCS coordinators face many challenges:  new state requirements; inconsistent file upload formats;  updated coding every quarter; and error-free submission requirements. DataGen can help you meet these challenges with our UDS (UIS Data System™) software, SPARCS expertise an...

Healthcare providers face difficult choices that can pit their number one priority ─ care quality ─ against the need to reduce costs and increase efficiency. Healthcare providers can achieve all of these goals using data analytics. An analytics-first strategy enables hospitals, health systems and state hospital associations to make data-informed decisions, not best guesses. This proactive approach can illuminate trends and provide real-time insights that are often hidden or seen too late to change outcomes. Data from your Medicare quality programs tell a compelling story, 24 hours a day, 365 days a year. DataGen uses Medicare impact modeling, expert analysis and visualizations to reveal data-informed narratives about your performance on three CMS programs: Value-Based Purchasing (VBP); Readmission Reduction Program (RRP); and Hospital-Acquired Conditions (HAC) Reduction Program. Do you know your organization’s stories? The biggest and best tool in your healthcare management toolkit: Da...

Doing something the way you’ve always done it gets you the results you’ve always gotten. When it comes to the Agency for Healthcare Research and Quality’s Survey on Patient Safety Culture™ (SOPS®), is that enough? Not in today’s competitive, post-COVID-19 market. Your SOPS® scores matter far beyond basic compliance with The Joint Commission and other accrediting organizations. With the public’s growing awareness of patient safety issues, an unfavorable reputational impact can quickly spread across the patient and provider community. Here are five secrets designed to help you get better SOPS® insights, improve your scores and transform your organization. Start by asking yourself a few simple, direct questions: What is your current SOPS® response rate? Is it near the minimum required response of 60%? Has your hospital’s rate stayed in the same stubborn response range for multiple survey cycles? “One and done” will get you nowhere. Results are only worthwhile if your staff can easily subm...

CMS has issued its first evaluation report for Primary Care First . The report offers a window into: key attributes of advanced primary care practices; strategies for lowering costs and reducing hospitalizations; and new strategies that signal practice transformation. Future PCF program evaluations will include which practice implementations worked and how they improved quality. In the meantime, even if your medical group is not a PCF participant, you can glean insight into what CMS is looking for as it evolves its Alternative Payment Models and how practices committed to value-based care are prioritizing and evolving their practice transformation strategies. First, some background on PCF. PCF: Focus areas, risk models and payments PCF is designed to improve care quality and patient experience, increase access to advanced primary care services and reduce expenditures. PCF builds upon CMS’s Comprehensive Primary Care Initiative (CPC Classic) and Comprehensive Primary Care Plus by adding...

To build a better medical practice, you must transform and then sustain the change. Through customized engagements and best practice experience, Practice Advancement Strategies guides clinical teams through the following challenges and opportunities: staff shortages/burnout; practice culture; payer negotiation and contracting; and value-based care outcomes These will be hot topics at the next Medical Group Management Association event: the Medical Practice Excellence: Financial and Operations Conference , just around the corner in Orlando, March 19-21. To help you prepare — for the conference or progress in general — DataGen Practice Advancement Strategies offers the following insider tips for practice advancement. 1.   Transformed teams can transform patient care. Research shows that earning Patient-Centered Medical Home Recognition from the National Committee for Quality Assurance can reduce staff burnout by more than 20%. While workforce shortages clearly impact burnout, c...

The Centers for Medicare and Medicaid Services Innovation Center recently announced approved applicants for the new Enhancing Oncology Model. If your facility has been selected by CMS, are you still weighing your options during the current baseline evaluation period?  Two deciding factors may include the program data that CMS provides and whether EOM is enough of an improvement over the prior Oncology Care Model to make your investment worthwhile. Another factor to consider: Will you have the resources in place to conduct a baseline evaluation before EOM’s program start on July 1, 2023? How EOM differs from OCM EOM aims to improve the coordination of oncology care, drive practice transformation and reduce Medicare fee-for-service spending through episode-based payment. It includes three major updates: Fewer cancer types. Compared with OCM’s 21, EOM will be limited to seven common cancer types: breast, prostate, lung, small intestine/colorectal, multiple myeloma, lymphoma and chroni...